SU0011260 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- -------------- )Complete in Tdpticate) Permit No. -.�/: /I....... ............. .--._-----_.-----_ This Permit Expires 1 Year From Date Issued Date Issued S A7.-_7/..... _.__--__ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mpade.in compliance wwiitthh County Ordinance No. 549 and existing Rules and Regulations.. y 1 JOB ADDRESS/LOCATIONQCd-�.. ...............CENSUS TRACT .----"7.. ---------- F Owner's Name :.{.(la.`LI: /Ill. `. ... Gd S - :....... )- '-,.. J- Phone d. �� 1 Address . ) ir;�1_.---Roy,..._-A_2..0 ... - -.. .......-----......q_,City .h .%�Q.<�r,..... -- 3 p-_d_!la- .. _- -- J--.License # Grll --- Phone/v _K:T3Z.2.-��--'.7 ' Contractor's Name ....,,�/� � �.�+"� ------ - Installation will server - Residence ❑Apartm/ent•House f1]/ComLmLercial ❑Traller Court ' Motel ❑Other---�rnai.,l-P...... !�.ON!- „-_' i y� Number of living units:---)_.....: _ Number of bedrooms . _ .__.Garbage Grinder _. .. ...: Lot Size .,rTrO __.7..dpicpp� Water Supply: Public'System and name ---------------------------------------- ------------- ...--------------------------- ---.....Private ❑ 1 ' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam X Clay Loam.[3 Hardpan ❑ Adobe'❑ Fill Material ............ If yes,type .............I.............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewers available within 200 feet') PACKAGE TREATMENT [ I SEPTICTANK © Size.../_ -r. --- -----------. Liquid Depth --- . .........__ ' Capacity IW.OQyrok1. TypeX-rG'.. S.irMoteric!12 i No. Compartments ...Z............... Distance to nearest: Well ......... ............. .Foundation Pro .,1}ne e f Li N LEACHING LINE [ o. of --- .--.. -- Length of each line-- -.%�:. ' - Total L ngt_ d l.... ' e _„* _72. pt y�v� D' Box Type Filter Materials ..__._`----- lUepth Filter Materia( ..... _ ...._-------------- --------- Distance to nearest: Well -0 -.-__-- Faunlation .._f 0..�_..----- Property Line. ..�............. ' SEEPAGE PIT [ ] Depth _,/.6......_.... Diameter...............1.�Number .....f............... .... Rock Filled Yes ® No ❑ s 4 Water Table Depth ._.__.._.-. --------Rock Size ...Z.`.`l1._---.------- �- ------------------------- T' Distance to nearest: Well _...........__------------------_-..Foundation -------- .......---- Prop. Line ...................... `7 ......... Date ........• .. -------- ----------- r 'TtEPAIR/ADDITION(Prev. Sanitation Permit t4` ................................... ..---- -- - - Septic Tank (Specify Requirements) - -------- --.................. ...............- --- ----...........------•------------ ._......... Disposal Field (Specify Requirements) ---------- -------------------------------------------------- ------------ ---------- --- -- ............ +y 1 a ------------------- ...Dra..... - - .._. .......r...uire...a -- ...rev -._.std ............. --- ...._..............._......_...,........ ` (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or I(cen- ' sed agents signature certifies the following: 111 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco�m/'e ajest to Worl a ' Co ensaHon laws of California;”Owner; ' SignedGll. .��w�.. re,G .. �41 ' `.:title _..._� _ ...................... By•.::......... ---- c (If other than owner).-,...k \. , ' FOR:.D�EPARTMENT USE ONLY APPLICATION ACCEPTED BY ,.------ . r 2-. DATE BUILDING PERMIT --DATE ADDITIONAL COMMENTS 'eirn•x._.ti.1'..`- ---- �� ----v ------- .r_ ----�--------,-... . _ ................... . ----------- --------------------- ... - ---1......... ------- .. . I----- --- Date Findljlnspectfon i -------—-- --Z----- - A t .ka SAN JC7AQUIN LOCAL HEALTH DISTRICT /`��/7 f C u a 1_'An env 5M --